Spravato (esketamine) treatment

What esketamine is

Esketamine is a form of ketamine available as a prescription nasal spray called Spravato. It is approved for treatment-resistant depression in adults and is used under medical supervision in a certified treatment center.

Spravato acts on the brain’s glutamate system, a different target from many common antidepressants. Researchers are still studying exactly how it improves depression symptoms.

Could Spravato be right for you?

Spravato may be an option when depression has not improved enough with previous antidepressant treatment.

During your evaluation, we will talk through your symptoms, the medications you have tried, and your medical history. We will discuss the potential benefits, risks, and other treatment options before deciding whether Spravato is a suitable next step.

What treatment involves

Treatment starts with a screening call and a psychiatric evaluation. If Spravato is recommended, our team will explain the treatment plan, insurance authorization steps, and registration in the Spravato Risk Evaluation and Mitigation Strategy (REMS) program.

At each visit, you will use the nasal spray under a healthcare provider’s supervision in a private treatment room. Staff will check your vital signs and monitor how you are feeling.

Plan for a visit lasting a little over two hours, including at least two hours of monitoring after the nasal spray. Your clinician will decide when you are ready to leave.

Payment and insurance

Our office is in network only with Blue Cross Blue Shield PPO. Spravato coverage depends on your plan’s criteria and may require prior authorization.

Before treatment, we will review your benefits and expected out-of-pocket costs with you. Approval timing varies by plan.

Other treatment options

If Spravato is not a good fit or does not help, we can discuss other approaches based on your symptoms and previous treatment. Options may include:

• Additional medication trials
• Psychotherapy
• Ketamine
• TMS at Lott Behavioral Health
• ECT or VNS through outside providers

Spravato patient resources

These manufacturer resources explain administration, treatment visits, and the REMS program. Review them alongside the instructions from your treating team.

• Watch the Spravato instructions video on YouTube
• Spravato patient brochure (PDF)
• Spravato REMS program

On the REMS website, select “Patients” for enrollment information.